Provider Demographics
NPI:1285668954
Name:DANIEL O BENSON, M.D., P.C.
Entity Type:Organization
Organization Name:DANIEL O BENSON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ORVILLE
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-883-3688
Mailing Address - Street 1:2615 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1176
Mailing Address - Country:US
Mailing Address - Phone:541-883-3688
Mailing Address - Fax:541-883-7565
Practice Address - Street 1:2615 ALMOND ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1176
Practice Address - Country:US
Practice Address - Phone:541-883-3688
Practice Address - Fax:541-883-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09357207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057232Medicaid
OR0000WFBXSMedicare ID - Type Unspecified
ORC92191Medicare UPIN